Heart & Cardiology/PH

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Question
I am now a 50 yr old female who is quite obese. I feel like I am o a roller coaster. About 5 years ago my rvsp came back on an echo as 42. I began having echos every 3-6 months. The RSVP increased to 60 and stayed there for about 3 years. Last year my echo said the RVSP was 42 and now a yr later is it 53. Some things were notated along the way but I will post what  the latest one says. No one seems all that concerned except for me. Please offer any help. Should I have the echo repeated?
Conclusions:
The study quality is poor
The LV chamber size is normal
mild concentric LV hypertrophy is observed
Estimated EF is 50-55%
Abnormal LV diastolic function is observed
Left and right atrium is mildly dilated
No evidence of aortic stenosis
Mitral valve appears normal in structure and function
Mild tricuspid regurgitation
RVSP calculated t 53%
evidence of moderate PH
No pericardia effusion

Answer
Hi, i had actually replied to this a while ago but i guess it didn't send!

I am actually asked this question a lot, and i guess cardiologists should spend longer explaining the results of echocardiograms to their patients, as it is clearly of concern to them! Your echo is relatively normal in that cardiac structure and function is good.

The reason the RVSP is performed is that it provides an estimate of the pressure in the pulmonary arteries that supply the lung known as the PA pressure. The PA pressure is calculated by using the derived velocity of the tricuspid regurgitation jet and this is then added to the right atrial pressure, derived from the IVC to obtain an estimate. Importantly this is an estimate. There can be errors in the measurement of the tricuspid jet and also the IVC and therefore multiple sources of error in arriving at a final value. The person reading the echo officially usually reviews these components, but often there can be oversights. Even when accurately measured, an elevated PA pressure estimated form echo can still often be normal when more invasive studies such as cath are done.

Reassuringly pretty much all the components of your echo are normal otherwise Its reasonable to ask the simple question from your cardiologist, "Do I have pulmonary hypertension" (looks relatively mild even if you did). To answer that your echo will be reviewed and the components assessed for quality. If it is indeed confirmed you have a high PA pressure then the question is how high, is it affecting the right side of your heart, and do you have symptoms. A high pulmonary pressure can sometimes underlie shortness of breath.

I would ask your cardiologist for clarification of the above points, and to review the study. Ask if there is evidence of right sided heart strain. As if there are treatable causes in you for this (weight loss, treat sleep apnea, treat hypertension etc.). I wouldn't lose sleep over the findings you have as there are no critical findings on your echocardiogram. I would ensure that you confirm the findings and treat the treatable causes to ensure that there are no long term effects. If you have a high PA pressure, and symptoms or evidence of right heart strain, a right heart catheterization may be a good place to start.

Hope that was helpful,

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

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http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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